Monday, September 29, 2014

I am back on the infectious diseases consult service this week so my attention will be diverted to clinical care. Regarding infectious diseases cases, here is an interesting article published in Clinical Infection Diseases titled Death in the White House: President William Henry Harrison's Atypical Pneumonia.The article challenges the long maintained notion that pneumonia killed William Henry Harrison (1773-1841) just 1 month after he became the ninth president of the United States. A careful review of the detailed case summary written by his personal physician suggests that enteric fever, not pneumonia, was the disorder that killed the president. Although President Harrison did have some pulmonary symptoms, the case summary highlights the progressive abdominal symptoms that ultimately led to sepsis and death. Emphasis is placed on the unsanitary condition of early 19th century Washington, DC. The water supply of the White House was 7 blocks down from a repository of ''night soil", a euphemism for human feces. Given that a sewage system was non-existent, runoff most likely contaminated the water supply, increasing the likelihood of enteric fever. I previously blogged about the death of President Garfield, as chronicled in the Destiny of the Republic, another worthwhile read.Then, as in now, physicians subscribed to the tenet of primum non nocere. Ironically, unbeknownst to them, the treatments, both in the cases of Presidents Garfield and Harrison, were toxic and led to greater harm than good. Good intentions, bad results.

Tuesday, September 23, 2014

I am back to my medical blog after a much needed break.In honor of Anton Van Leeuwenhoek, the founder of the microscope, I refer you to this animated video from the New York Times titled Seeing the Invisible.As an infectious diseases specialist I have plenty of respect for microbes. The goal is not to kill or eradicate all bacteria, rather, to target treatments such as to minimize adverse consequences, maintain our homeostasis and preserve the symbiosis between man and microbes.

Monday, September 1, 2014

Here is an article published in the American Journal of Preventive Medicine that provides the most up to date assessment of mandatory influenza vaccination of healthcare workers.

This can be a very emotionally charged subject for many people. What evidence is there to support mandating the influenza vaccines in healthcare workers?Twelve observational studies were included in the study from 778 citations. The data suggest that implementation of a vaccine mandate will without doubt increase vaccination of healthcare workers, exceeding 94%. But what are the health benefits for healthcare providers and patients? This is much less clear. Two single-institution studies reported limited, inconclusive results on absenteeism among healthcare workers. We still cannot answer whether vaccination will result in fewer sick days by staff. Importantly, no studies reported on clinical outcomes among patients. We simply do not know if mandatory vaccination of healthcare workers will result in improved patient safety as the appropriate studies have not been done.Mandatory influenza vaccination of healthcare workers is not backed by sound evidence, either for staff or patient outcomes. This is disappointing and mandatory vaccination may be an overreach.Fortunately, the vaccine is safe.